12 March 2004

Anorexics make perfect perfectionists

Anorexics, who risk their health in the quest for a perfect body, are more likely to be perfectionists in all aspects of their lives than people without eating disorders.

Anorexics, who risk their health in the quest for a perfect body, are more likely to be perfectionists in all aspects of their lives than people without eating disorders, says a new multinational study.

The findings are considered the first step toward discovering a possible genetic basis for anorexia nervosa.

“We are trying to find traits that make people susceptible to eating disorders, and this study suggests perfectionism may be one of those traits," says Dr. Walter Kaye, a psychiatry professor at the University of Pittsburgh and one of the study's authors.

Anorexia nervosa and other eating disorders affect 8 million Americans, says the National Association of Anorexia Nervosa and Associated Disorders.

Working with women from the United States, England and Germany, the research team compared more than 300 women with anorexia with 44 healthy women of average weight who had no known eating disorders.

The anorexics were put into three groups: those who had extreme food restrictions, those who purged and those who would binge and purge.

“Perfectionism was high in all the anorexia subtypes," says lead author Dr. Katherine Halmi, a psychiatry professor at Weill Medical College of Cornell University and director of the eating disorders programme at the Westchester Division of the New York Presbyterian Hospital.

And the country the women came from didn't seem to matter, she says.

“This study very solidly defined that perfectionism is a robust characteristic of anorexia, and now we need to see if that trait is transmitted in the genes," Halmi says. Findings appear in the November issue of the American Journal of Psychiatry.

“I think the study confirms a lot of what we've known," says Dr. Ira Sacker, director of adolescent medicine, director and founder of the eating disorders programme HEED (Helping to End Eating Disorders) at Brookdale University Hospital and Medical Center in New York City.

“(The study) points us in the direction we've seen empirically: that perfectionism has an underlying effect on anorexia patients."

What To Do
At this point, the findings will have little effect on the treatment or prevention of anorexia, except to emphasise that therapy should address perfectionist tendencies, says Halmi.

Kaye says more traits will be identified in the future, and that could give doctors the tools to prevent eating disorders.

Meantime, Sacker recommends more education for parents, teachers and physicians, and he urges physicians to be alert for signs of eating disorders.

He says he sees children as young as five and six concerned with counting fat grams, a likely sign of trouble down the road.

Sacker says other signs to watch for are weight loss, mood swings, behaviour problems, lower grades, social isolation, dark circles under the eyes, yellowish discoloration on the palms and soles of the feet and, in women, a loss of menstruation.

Interesting books:
In and out of anorexia: The story of a client, the therapist and the process of recovery
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